Definition:
Cirrhosis is the end-stage of chronic liver disease, marked by diffuse fibrosis, regenerative nodules, and loss of normal liver architecture, resulting in impaired hepatic function and portal hypertension.
Etiology:
- Chronic viral hepatitis:
- Hepatitis C (most common globally)
- Hepatitis B
- Chronic alcohol abuse (alcoholic liver disease)
- Biliary diseases:
- Primary biliary cholangitis (autoimmune)
- Primary sclerosing cholangitis
- Metabolic disorders:
- Hemochromatosis (iron overload)
- Wilson’s disease (copper accumulation)
- Alpha-1 antitrypsin deficiency
- Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH)
- Drug-induced liver injury (e.g., methotrexate, amiodarone)
Pathogenesis:
- Chronic liver injury → activation of stellate (Ito) cells → transformation into myofibroblasts
- Myofibroblasts produce collagen, leading to:
- Fibrosis of portal tracts and sinusoids
- Formation of fibrous septa
- Regenerative nodules of hepatocytes surrounded by fibrous bands
- These architectural changes cause:
- Distortion of vascular structures
- Portal hypertension
- Liver dysfunction
Symptoms:
Often asymptomatic in early stages.
General symptoms:
- Fatigue
- Weight loss, anorexia
- Weakness, cachexia
- Right upper quadrant abdominal pain
- Diarrhea or constipation
Signs in advanced stages:
- Hepatomegaly
- Splenomegaly
- Ascites
- Jaundice
- Palmar erythema, spider angiomas
- Gynecomastia (due to estrogen excess)
- Caput medusae (dilated abdominal wall veins)
- Confusion, coma (hepatic encephalopathy)
- Bleeding/bruising (coagulopathy)